The Impact of Antioxidants on Vitiligo and Melasma: A Scoping Review and Meta-Analysis.

Reactive oxygen species (ROS) generated during melanogenesis make melanocytes particularly vulnerable to oxidative stress, influencing their survival and melanin synthesis. Oxidative stress, significantly present in vitiligo and recently also detected in melasma, triggers inflammatory cascades and melanogenesis, making antioxidants a promising therapeutic avenue. A systematic search was conducted on Embase and Pubmed to study the efficacy of antioxidants for treating vitiligo and/or melasma. Meta-analysis was performed to assess the difference in Melasma Severity Index (MASI) scores between baseline and follow-up. Various antioxidants like polypodium leucotomos, ginkgo biloba, catalase/superoxide dismutase, and vitamin E have potential in vitiligo. For melasma, vitamin C, silymarin, and niacinamide were among those showing promise in reducing pigmentation, with vitamin C displaying significant effects in meta-analysis. Different antioxidants improve both vitiligo and melasma, with an increased minimal erythema dose (MED) following UV exposure being significant for vitiligo and tyrosinase inhibition being crucial for melasma. However, the efficacy of individual antioxidants varies, and their exact mechanisms, especially in stimulating melanocyte proliferation and anti-inflammatory pathways, require further investigation to understand better and optimize their use.

The COVID-19 Pandemic and Recent Earthquake in Zagreb Together Significantly Increased the Disease Severity of Patients with Atopic Dermatitis.

BACKGROUND/OBJECTIVE: Stress may affect patients with atopic dermatitis (AD). The aim of this study was to examine the impact of the COVID-19 pandemic and the earthquake in Zagreb, Croatia (March 2020), on AD patients and their disease severity, symptoms/itch, and perceived stress. METHODS: Our observational cross-sectional study included three groups of AD patients diagnosed by a physician: group 1 (n = 50), who experienced both the pandemic (quarantine) and the earthquake; group 2 (n = 50), who experienced only the pandemic; and group 3 (n = 50), the comparison group, who experienced neither disaster (patients examined 2018-2019). Groups 1 and 2 were examined May-June 2020, immediately after the national lockdown/quarantine. Disease severity (SCORAD), data from the Perceived Stress Scale (PSS), and information on patients' confirmed allergies were recorded for all groups, while groups 1 and 2 additionally completed a questionnaire concerning their disease, hand hygiene, and experience during the pandemic and/or earthquake. RESULTS: The patients exposed to both disasters reported more pronounced AD worsening (p < 0.001; r = 0.388) and more frequent itching (p < 0.001; r = 0.350) than those exposed to the pandemic only. Notably, we found certain differences by gender: during the pandemic, women significantly more frequently washed their hands (81% of women washed "very frequently," while 52% of men washed "quite often") and had significantly higher PSS levels than men (p < 0.05). Concerning allergies, present or absent, during the pandemic, there was no significant difference in SCORAD between groups 1 and 2, neither when analyzed separately for indoor nor for outdoor allergens. The most commonly reported psychological disturbances during the pandemic were concern (46%), anger (18%), anxiety (16%), depression (9%), and increased alcohol, cigarette, and opioid agent use (6%). CONCLUSION: The COVID-19 pandemic together with the earthquake significantly increased disease severity and influenced AD worsening, itching, and psychological disturbances. This indicates that stressful events meaningfully affect the course of AD.

Cheilitis: A cross-sectional study-multiple factors involved in the aetiology and clinical features.

OBJECTIVE: Since the aetiologies of cheilitis are broad and overlapping, the purpose of this cross-sectional clinical study was to examine the multiple factors involved in aetiology and the disease's clinical features. SUBJECTS AND METHODS: We analysed cheilitis prevalence, demography, clinical features, patients' habits, psychological stress, systemic diseases, vitamin B9, B12 and iron serum levels and allergy test results in a total of 130 subjects with cheilitis, plus 22 healthy subjects. RESULTS: The most common cheilitis types were: cheilitis simplex and eczematous cheilitis (28.5%); herpetic cheilitis (16.9%); and exfoliative and angular cheilitis (7.7%). Concerning bad habits, there was a significant association/connection between self-reported saliva at the corners of the mouth and angular cheilitis, and between lip licking/biting and exfoliative cheilitis. Common associated conditions were skin diseases (56.5%) and atopy (84%). Vitamin B9 and B12 serum and iron values were mostly within the normal reference range. The patients suffering from herpetic cheilitis had significantly higher psychological/mental stress levels than the control group. CONCLUSION: To our knowledge, this is the first study of cheilitis patients that has simultaneously analysed aetiological factors, characteristics of the disease and diagnostic parameters.

Trends in dermatological practice in work with patients with skin diseases during the COVID-19 pandemic: our experience and observations.

The COVID-19 pandemic has changed many areas of life, including habits and trends in dermatological practice and dermatology patients' lifestyles. This article presents cases of patients infected with COVID-19, patients that developed lesions due to pandemic-related public health measures affecting the skin, and those that developed skin lesions after COVID-19 vaccination. One case concerned a female patient with widespread urticaria that had repeatedly gone to emergency rooms and had been administered corticosteroids and antihistamines for an undiagnosed COVID-19 infection that had been triggering her urticaria outbreaks. Another patient complained of urticaria outbreaks and was examined and treated multiple times at emergency rooms until a dermatological follow-up determined he was suffering from dysmorphophobia. Among those with lesions due to frequent hygiene during the pandemic, we examined a female with contact dermatitis triggered by repeated and prolonged contact with hand disinfectant. Another patient presented with a phototoxic reaction on the neck after using hand disinfectant. In addition, we saw widespread lesions on a patient that reported recently being vaccinated against COVID-19. Finally, in an effort to prevent COVID-19 transmission, we believe that a first-time onset of non-specific exanthema indicates COVID-19 testing because it may be an early indicator of viral infection.

Brentuximab-induced splinter nail haemorrhages in a patient with Sézary syndrome: A case report.

Sézary syndrome is a systemic variant of cutaneous T-cell lymphoma characterized by erythroderma, lymphadenopathy and circulating atypical lymphocytes (Sézary cells). It may present with nonspecific lesions on multiple digits. We describe an atypical case of brentuximab-induced splinter nail haemorrhages in a patient with Sézary syndrome, associated with a poor prognosis during follow-up. Concomitantly with the appearance of nail lesions, significant lymphocytosis was detected as well as infiltration of bone marrow and nail matrices. The lesions followed a precise sequence, which can be traced back to the monthly application of brentuximab and its direct cytotoxic effect on CD30+ T lymphocytes in the nail matrix. Brentuximab-induced nail lesions might be associated with decreased efficacy of brentuximab in this patient with advanced cutaneous T-cell lymphoma.

Main Clinical Features of Patients with Irritant and Allergic Contact Dermatitis on the Hands in Correlation with Skin CD44 Expression: A Prospective Study.

Contact dermatitis (CD), including its irritant (ICD) and allergic (ACD) types, is a complex, often chronic and therapy-resistant disease that significantly affects patient quality of life and healthcare systems. Objective of this study was to examine the main clinical features of patients with ICD and ACD on the hands through follow-up in correlation with baseline skin CD44 expression. Our prospective study involved 100 patients with hand CD (50 with ACD; 50 with ICD) who initially underwent biopsies of skin lesions with pathohistology, patch tests to contact allergens, and immunohistochemistry for lesional CD44 expression. The patients were subsequently followed-up on for a year, after which they filled out a questionnaire designed by the authors examining disease severity and disturbances/issues. Patients with ACD had significantly higher disease severity than those with ICD (P<0.001), with more frequent systemic corticosteroid treatments (P=0.026) and greater areas of affected skin (P=0.006), exposure to allergens (P<0.001), and impairment of everyday activities (P=0.001). No correlation between ICD/ACD clinical features and initial lesional CD44 expression was observed. Due to the commonly severe course of CD, especially ACD, more research and prevention are needed, including the analysis of the role of CD44 in connection with other cell markers.

Painful and Itchy Dermatoses Carry the Highest Psychological Burden for Dermatovenereological Patients.

BACKGROUND: Most dermatovenereological diseases are not life-threatening but nevertheless are highly prevalent disorders. Psychosocial aspects of skin diseases and physical symptoms strongly influence patient's quality of life (QoL) which results in the development of different coping mechanisms in patient's behaviour. Development of psychiatric comorbidity in patients with skin diseases is well known. On the other hand, little is known about psychological comorbidity associated with dermatovenereological diseases. Aims of this study were to investigate QoL and psychological burden among dermatovenereological patients. SUBJECTS AND METHODS: Two hundred and ninety patients suffering from different dermatological and venereological diseases participated in the study, divided into three study groups: itchy/painful dermatoses, non-itchy/non-painful dermatoses and venereological diseases. Participants completed standardized psychological questionnaires: Dermatology Specific Quality of Life (DSQL), Beck Depression Inventory (BDI) and State and Trait Anxiety Inventory (STAI). Intensity of the disease and localisation of the lesions were also assessed. RESULTS: Physical aspect of QoL was mostly influenced by itchy/painful dermatoses but psychological aspect and everyday activities and choices were mostly affected by patients with non-itchy/non-painful dermatoses and venereological diseases. 4.1% of participants had serious depressive symptoms, 11.5% had high and very high anxiety symptoms as state and 15.6% as trait. However, participants with severe skin conditions were more depressed, while participants with always and sometimes exposed lesions were more anxious. CONCLUSION: It is essential to recognise subgroups of dermatovenereological patients whose treatment approach should be interdisciplinary. Further studies are needed to detect psychosocial needs of patients with venereological diseases.

Pembrolizumab-induced vitiligo in a patient with lung adenocarcinoma: A case report.

Pembrolizumab is an immune checkpoint inhibitor designed to block the interaction between programmed cell death-1 and programmed cell death-ligands 1 and 2. It shows efficacy in the treatment of patients with advanced nonsmall-cell lung cancer, among others. Side effects may involve immune-related adverse events, including vitiligo. We hereby present a 63-year-old Caucasian female with metastatic nonsmall-cell lung cancer. Immunohistochemical analysis showed programmed death-ligand 1 expression on 100% of tumour cells. The patient was eligible for immunotherapy and received pembrolizumab every 3 weeks as the first-line treatment. Three months after initiation of immunotherapy with pembrolizumab, depigmentation appeared on her upper right thoracic area of the skin overlying the affected lung lobe. Immunotherapy was generally well tolerated. Excellent response in our subject with complete remission during 16 months of follow-up potentially indicates that cutaneous immune-related adverse events, such as vitiligo, might be associated with increased efficacy of pembrolizumab in metastatic lung adenocarcinoma.

Study on the Impact of Psoriasis on Quality of Life: Psychological, Social and Financial Implications.

BACKGROUND: Psoriasis is a chronic and stigmatising disease with significant and hard to meet clinical needs in patient management. Psoriasis is a relatively common disease, affecting up to 2% of the population. The impact of psoriasis on quality of life is significant given its chronicity and visibility. Psychological stress is a well-established systemic triggering factor in psoriasis. It has been associated with initial presentation of the disease as well as exacerbations of pre-existing psoriasis. The purpose of this study is to assess the psychological, social and financial implications of psoriasis. SUBJECTS AND METHODS: 51 patients participated in this study. After dermatological examination and determination of Psoriasis Area and Severity Index score, patients were referred to a psychological consult. Assessment was done through questionnaires concerning quality of life, depression, anxiety, illness perception, financial domain and personal data. RESULTS: Results of our study indicate that psoriasis has a strong impact on patients' life. It influences working habits, poses a significant financial burden, but most of all, significantly impairs their quality of life and psychological status. CONCLUSION: Psoriasis poses a substantial threat to several dimensions in patient's quality of life. Patients feel that the current treatment, although often effective, does not provide a satisfactory long-term solution. Thus, long-term psychologic support for patients with psoriasis is desirable.

Autoimmunity in Segmental Vitiligo.

The autoimmune basis of segmental vitiligo (SV) has only recently been recognized. Systemic autoimmune diseases are less frequently associated compared to non-segmental vitiligo (NSV), but localized skin disorders - in particular linear morphea - have been repeatedly observed in patients with SV. The inflammatory response is documented on a clinical level with cases displaying erythematous borders or a hypochromic stage, on a histopathological level with predominantly CD8 lymphocytes migrating toward the basal layer and by flow cytometry demonstrating the antimelanocyte specificity of these cytotoxic T cells. The increased risk for halo naevi and NSV in these patients further underline the immune-mediated mechanisms of SV. Nonetheless, the localized and unique distribution pattern points to somatic mosaicism. This places SV in a category of similar diseases such as lichen striatus, blaschkitis, linear lupus erythematosus, and linear scleroderma where an immune reaction against genetically mutated skin cells is believed to be the underlying cause. All these disorders are characterized by a young age of onset, a temporary disease activity with spontaneous resolution, limited response to treatment, and often long-term sequelae. Although challenging, genetic research proving this genetic mosaicism could offer crucial insights into the pathogenesis of both segmental and non-segmental vitiligo.

Yeast extract demonstrates rapid itch relief in chronic pruritus.

BACKGROUND: Pruritus is the most common complaint encountered in dermatological practice. It is estimated that up to 4% of the world population suffers from chronic itch. Chronic pruritus can be associated with both cutaneous or systemic conditions. While a plethora of treatments attempt to address itch, most carry risk of significant adverse events with chronic use; thus, there exists an unmet need to develop safe treatments for chronic pruritus. A recent study demonstrated that a novel extract from Saccharomyces cerevisiae, that is, Baker's yeast, blocks various histamine receptors as well as inhibits numerous inflammatory cytokines. METHODS: Given the long-term safety profile of Baker's yeast, we set to investigate the efficacy of the novel extract in the treatment of chronic pruritus. KEY RESULTS: In our study, we demonstrated that within 30 minutes, the novel extract significantly reduced itch when compared to a placebo lotion (P = .0020). CONCLUSIONS: To our knowledge, this is the first study demonstrating that a novel extract from Saccharomyces cerevisiae can provide rapid and sustained itch relief to chronic pruritus patients.

FACTORS CONTRIBUTING TO CHRONIC URTICARIA/ANGIOEDEMA AND NUMMULAR ECZEMA RESOLUTION - WHICH FINDINGS ARE CRUCIAL?

When working with dermatology patients, the question sometimes arises which diagnostic tests and tools should be used for workup, particularly in cases of chronic urticaria (CU) and discoid nummular eczema, where the treatment of associated systemic diseases and infections may be crucial for patient outcome. The aim was to investigate retrospectively the influence of associated diseases on skin disease outcomes based on medical records of CU and nummular eczema patients in comparison to controls. We included patients admitted to our Dermatology Department over a 6-year period and analyzed their laboratory findings, related factors and outcomes recorded after two years of workup and treatment. Compared to controls, CU patients had a significantly higher prevalence of positive Helicobacter (H.) pylori findings (p=0.020), confirmed allergies (p=0.006), increased IgE (p=0.011) and pathologic thyroid findings (p=0.049), whereas nummular eczema patients only had significantly higher positive H. pylori findings (p=0.046). Meaningful regression of both dermatoses was recorded after treatment of associated diseases, with significant benefit from H. pylori treatment. This indicated that the diagnosis of associated infections (particularly H. pylori and urogenital infections), confirmed allergies, endocrine disorders (particularly of thyroid gland in CU patients) and serum malignancy markers could play a crucial role, as their treatment may improve disease outcomes.

Prevalence of hair shedding among women.

Hair shedding in female patients is a frequent complaint in dermatological, endocrinological, and gynecological consults. Previously, the Sinclair Hair Shedding Scale was developed to assess normal versus excessive hair shedding in female pattern hair loss (FPHL) subjects. However, the prevalence of hair shedding in females not suffering from FPHL is unknown. To gain better understanding of hair shedding in the general population, we recruited 300 subjects visiting a public hospital for conditions other than alopecia. Of the 300 subjects recruited, 263 did not suffer from FPHL. Among those subjects, approximately 40% reported experiencing excessive hair shedding (as defined by the Sinclair Hair Shedding Scale) on hair washing days. In comparison, in our subject population, approximately 60% of subjects with FPHL reported excessive hair shedding on hair washing days. To best of our knowledge, this is the first study to quantify the prevalence of hair shedding in women. While, no treatment currently exists for this condition, we hope that this study would encourage physicians and researchers to address this frequent concern.

OCCUPATIONAL CONTACT DERMATITIS AMONGST DENTISTS AND DENTAL TECHNICIANS.

Since the working medical personnel including dentists and dental technicians mainly use their hands, it is understandable that the most common occupational disease amongst medical personnel is contact dermatitis (CD) (80%-90% of cases). Development of occupational CD is caused by contact of the skin with various substances in occupational environment. Occupational etiologic factors for dental personnel are foremost reactions to gloves containing latex, followed by various dental materials (e.g., metals, acrylates), detergents, lubricants, solvents, chemicals, etc. Since occupational CD is relatively common in dental personnel, its timely recognition, treatment and taking preventive measures is needed. Achieving skin protection at exposed workplaces is of special importance, as well as implementing necessary measures consequently and sufficiently, which is sometimes difficult to achieve. Various studies have shown the benefit of applying preventive measures, such as numerous protocols for reducing and managing latex sensitivity and other forms of CD in dentistry. Active involvement of physicians within the health care system, primarily dermatologists, occupational medicine specialists and general medicine doctors is needed for establishing an accurate medical diagnosis and confirmation of occupational skin disease.

Vitiligo in Croatia: a case report.

Vitiligo is an acquired, chronic, multifactorial disorder which involves complex interactions between genetic risk factors and environmental triggers. It is characterized by scattered circumscribed depigmented macules and patches anywhere on the skin that result from loss of functional melanocytes. According to our statistical data, 1.6% of the general population in Croatia suffers from vitiligo, but varies based on region. It affects all age groups equally, with female patients being more affected (53.95%) than male patients, and no difference in severity of vitiligo. We present a case of a sudden onset of vitiligo vulgaris from a female patient in her twenties, treated at the Department of Dermatology and Venereology. Her 12-year-old brother simultaneously developed acrofacial vitiligo, six months after their mother died in a car accident. She has been previously diagnosed with type I diabetes and autoimmune endocrinopathies. The depigmented patches covered approximately 60% of her body, with Koebner response on trauma. Although no characteristic UV fluorescence was detected on the affected area, histopathological and immunohistochemical analyses revealed a complete loss of melanocytes, while Langerhans and dermal dendritic cells replaced the DOPA-positive melanocytes. TSH levels were elevated, and the ultrasound showed thyroid enlargement, which substantiated for a hypothyroidism therapy. Treatment by systemic corticosteroids for a 6 month period was successful in stabilizing the disease.

Benefits of controlled ultraviolet radiation in the treatment of dermatological diseases.

Phototherapy is a second-line treatment modality for the most common dermatoses that is safe and effective. Most phototherapy regimens denote the use of ultraviolet (UV) radiation of different wavelengths in the management of several dermatoses. Currently, irradiations with broadband UVB (290-320 nm), narrowband UVB (311-313 nm), 308 nm excimer laser, UVA 1 (340-400 nm), UVA with psoralen (PUVA), and extracorporeal photochemotherapy (photopheresis) are being used. Beneficial effects of UV radiation are far from being completely understood. Dermatoses that may benefit from such approach are numerous, with psoriasis, parapsoriasis, atopic dermatitis, cutaneous T-cell lymphomas, morphea, and vitiligo vulgaris as main indications. UVB radiation primarily acts on cells at the epidermis and the epidermodermal junction, while UVA radiation affects epidermal and dermal components, especially blood vessels. UVradiation has im- mediate and delayed effects. Immediate effects are the formation of DNA photoproducts and DNA damage leading to apoptosis of heratinocytes, Langerhans cells, activated T-lymphocytes, neutrophils, macrophages, NK cells, fibroblasts, endothelial cells, and mast-cells, cell membrane damage by lipid peroxidation, and isomerization of chromophores such as urocanic acid. Delayed effects include synthesis of prostaglandins and cytokines that play important roles in immune suppression. Systemic and local immune suppression, alteration in cytokine expression (induction of interleukin-1 (IL-1) receptor antagonist, decrease in IL-2, increase in IL-IO, IL-15), and cell cycle arrest may all contribute to the suppression of disease activity. PUVA is a form of controlled and repeated induction of phototoxic reactions which uses UVA light to activate chemicals known as psoralens. The conjunction of psoralens with epidermal DNA inhibits DNA synthesis and causes cell apoptosis. PUVA also causes an alteration in the expression of cytokines and cytokine receptors. Psoralens interact with RNA, proteins and other cellular components and indirectly modify proteins and lipids via singlet oxygen-mediated reactions or by generating of free radicals. Psoralens and UV radiation also stimulate melanogenesis with variable effects in patients with vitiligo vulgaris. Extracorporealphotopheresis is treatment modality used in management of erythrodermic cutaneous T-cell lymphomas. It is very potent in induction of lymphocyte apoptosis. Despite the introduction of numerous potent bioengineered systemic medications in the field of dermatology, phototherapy remains established, and often preferred, option for the most common dermatoses.

[Guidelines for the diagnosis and treatment of psoriasis]. / Smjernice za dijagnostiku i lijecenje vulgarne psorijaze.

Croatian dermatovenerological society of the Croatian Medical Association formed the working group which consists of leading experts for psoriasis in Croatia. After a critical analysis of relevant scientific papers, the working group has developed guidelines for the diagnosis and treatment of psoriasis.

Dermatological aspects of contact dermatitis from eyeglass frames and optical materials.

Although contact dermatitis (CD) from eyeglass frames is uncommon, occasionally it may be encountered. Various substances may cause allergic CD, including metals, cosmetics, plastics, rubber, solvents, antioxidants, dyes, and waxes, some of which can be found in the average eyeglass frame. Recently, it has been determined that plasticizers, UV stabilizers and nickel are the most common allergens. Thus CD from eyeglass frames should be suspected in patients with retroauricular dermatitis or with lesions on the point of contact with the skin. Sometimes, the question is raised whether skin lesions result from allergy or just irritation. It has also been found that the varnish applied to eyeglass frames could be a source of nickel. Sometimes, although the frame looks silver or gold, it may contain nickel. Additionally, palladium or titanium eyeglass frames have also been reported to result in allergic CD. Some titanium frames contain palladium, which may cause CD. Plastic frames occasionally present the problem as they contain a combination of materials, making it difficult to determine the exact composition. Most plastic glasses are made of zyl or propionate, and may contain other materials, such as nylon, carbon, polycarbonate, optyl and polyamid. Patch (epicutaneous) test on contact allergens with analysis of softened scrapings from frames is a valuable diagnostic method for these patients. Although topical corticosteroid therapy results in transient clinical resolution, they do not preclude recurrences and changing frame material is often the only solution for these patients. Additionally, hypoallergenic eyeglass frames are also available on the market.